Microcephaly risk of Zika in first trimester could be as high as 13 percent

Tom Frieden can't choose between mosquitoes and tobacco companies, and Andy Slavitt just pitched Silicon Valley on why they should prioritize Medicaid. But first: A concerning update on the risk of brain defects linked to Zika virus.

MICROCEPHALY RISK IN BRAZIL OUTBREAK: AS HIGH AS 13 PERCENT — That's according to researchers in NEJM who studied the Zika outbreak in Bahia and found a "strong association" between the risk of microcephaly and infection risk in the first trimester of a mother's pregnancy. Based on the researchers' models, the risk of brain defects was as low as 0.9 percent and as high as 13.2 percent.

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Meanwhile, researchers didn't find an association between Zika and microcephaly in the second and third trimesters — although it's worth noting, the research is preliminary.

HOUSE COMMITTEE CHAIR SAYS CDC MUST DO MORE TO RESTRICT TRAVEL — Science, Space and Technology Committee Chairman Lamar Smith called on the administration to raise the travel alert to Level 3 for Brazil, Colombia and other countries with high levels of Zika infections. Under that level, CDC urges Americans to "avoid nonessential travel" — a warning that the agency issued during the Ebola epidemic in West Africa.

"These dangers raise serious questions about the administration's handling of travel alerts," Smith said in a statement on Wednesday. More for Pros.

— How CDC officials respond: "The CDC has issued clear travel warnings to protect those most vulnerable to Zika infection, recommending that pregnant women not travel to countries where there is active Zika transmission," an agency spokesperson told PULSE. "While it's good to see that Congress is focused on the issue, the most important step it can take is the one it has so far failed to - funding the emergency supplemental request the administration made in February."

CDC'S TOM FRIEDEN ON OPIOIDS, PUBLIC HEALTH AND MORE — The head of CDC sat down with POLITICO's "Pulse Check" podcast to discuss the latest progress on fighting the Zika outbreak and theopioid epidemic, what he sees as the most overlooked disease, and much more.

And coming later today for Pros: More context on how Frieden views the Zika virus threat.

THIS IS THURSDAY PULSE — Where Bernie Sanders and Danny Glover's team-up to talk high drug prices last night left us craving a geriatric version of "Lethal Weapon." The tagline? "We're getting too old for this stuff, and we've got the pharma bills to prove it." Tips to ddiamond@politico.com or @ddiamond on Twitter.

WHY MISSOURI RULING COULD BE BAD NEWS FOR AETNA-HUMANA MERGER — The state's department of insurance on Wednesday rejected the two companies' planned merger, saying that the deal would be anticompetitive. It's giving Aetna and Humana 30 days to submit a plan to remedy that.

The regulators' key point: That Medicare Advantage should be considered a distinct market, separate from the traditional fee-for-service program, in terms of analyzing competitiveness. Combined, Aetna and Humana would control 70 percent of the Medicare Advantage market in 33 Missouri counties; they'd also become the largest Medicare Advantage plan in the nation.

What's next:One state's decision won't sink the entire $37 billion merger, experts tell Pro's Paul Demko. But Missouri's ruling could be a template for other states' actions and even the Department of Justice, too.

David Balto, a former antitrust official with both DOJ and FTC who’s organized opposition to the mergers, was exultant over the aggressive action of Missouri regulators. “Today’s the day the deal starts really cratering,” he told PULSE. “It’s a clarion call to other states and to the JusticeDepartment about why this merger is clearly anticompetitive.”

ALEXANDER: SENATE VOTING ON MENTAL HEALTH BILL IN JUNE — Sen. Lamar Alexander, co-author of the chamber’s primary mental health reform bill, said Wednesday he expects the Senate to vote on the measure in June. Speaking on the Senate floor, Alexander said Senate Majority Leader Mitch McConnell has signaled the bill will get floor time and he may even “interrupt the appropriations process if they can act quickly and not take a lot of floor time.”

… But it’s not a done deal. There are still several major obstacles facing the legislation, including how to pay for it. Plus, Sen. John Cornyn will offera controversial amendment containing NRA-backed language on gun background checks. That provision is a non-starter for Democrats who want to keep mental health reform separate from their gun control push.

Alexander, who previously told POLITICO he wants to keep guns out of his mental health bill, said Wednesday that he is in talks with Cornyn. Senate Republicans hotlined the bill two weeks ago to test out if it has enough support to get to the floor. McConnell’s office declined to say whether it will get floor time or not. Stay tuned.

On the other side of the Capitol, House Energy and Commerce Committee lawmakers are planning to mark up a version of Rep. Tim Murphy’s mental health reform bill in June. Committee staffers say lawmakers are still working out the final details and a final draft will surface soon.

** A message from the American Cancer Society Cancer Action Network (ACS CAN): Nearly 60 leading patient and provider organizations are urging Secretary Azar and Congress to stop proposed changes to Medicare Part D’s “six protected classes.” The current policy ensures patients have access to lifesaving therapies for complex medical needs. The proposed changes could put patients’ lives at risk. Learn more: fightcancer.org/sixprotectedclasses.**

ALEXANDER'S PUSH ON CURES CONTINUES — Alexander also said Wednesday that he is “mostly finished” with the Senate’s medical innovation package that’s been hung up on NIH funding since late last year.

Alexander reiterated he was “committed to seeing through” Senate legislation that would reform “problem-plagued” EHRs and other medical innovation efforts. “There is no excuse whatsoever for us not to get a result this year,” he said.

On the other side of the aisle: Democrats leading the House’s 21st Century Cures effort late last year said the Senate would need to pass something by Memorial Day to have enough time to conference with their bill, but they are pushing that date back.

Conferencing the Senate bill with the House-passed version won’t be difficult because there’s not a lot of substantive differences if the Senate can still pass something in the next couple of months, Rep. Diana DeGette told POLITICO's David Pittman in a brief interview today.

“I don’t think there’s going to be a lot of tough negotiations, so I still think we’re OK,” DeGette said. “But time’s a wasting. They need to get going on the pay-fors.”

WHY ANDY SLAVITT JUST PITCHED MEDICAID TO SILICON VALLEY — The head of CMS was in California to discuss how IT can be used to improve Medicaid, and he encouraged investors and tech companies to play a role.

"Investment gravitates to needs and problems it can solve," Slavitt wrote on Wednesday, ahead of hosting a forum on Sand Hill Road — the famous home of top venture capitalist firms. "There is no greater opportunity than bringing technical know-how, innovation and creativity to improve the health of Americans with health, social and economic challenges. "

They're also hiring: "We are actively recruiting a fulltime entrepreneur-in-residence fully committed to the Medicaid space," Slavitt added from California — a convenient place to scout out potential candidates for that role.

UBL CRITIQUES PART B DEMO, ICER — PhRMA CEO Steve Ubl blasted CMS’s proposed experiment with how it pays for physician-administered drugs in Medicare Part B, saying it may introduce a “bias toward older, cheaper medicines.” Speaking at a meeting of the Personalized Medicine Coalition Wednesday, he cited research showing that providers who dispense drugs that cost more than $480 would lose money under the proposed formula. “What gets lost,” he said, “are patients.”

… Ubl also criticized the cost effectiveness model developed by the Institute for Clinical and Economic Review, which issues reports onnew treatments. He said “where value assessments go astray is when they try to superimpose [cost thresholds] that are arbitrary.”

DOCTORS ON OPIOID EPIDEMIC: IT'S NOT ALL OUR FAULT — About 72 percent of physicians think that easy availability of opioids is the biggest cause of the current epidemic, while 63 percent said that overprescribing was to blame, according to a new HealthTap survey. Read the post: http://bit.ly/1ViUaaI

DOJ WADES INTO LAWSUIT AGAINST CALIFORNIA HEALTH SYSTEM — The False Claims lawsuit against Prime Healthcare alleges that CEO Prem Reddy and his team pressured doctors to unnecessarily admit patients, seeking to capture revenue.

It's the latest controversy for the 14-hospital health system, which has spent years being dogged by charges that Prime's practices are too profit-driven and put patients at risk. It's also reflective of the government's growing push to combat health care fraud.

$17.5 billion, and counting. That's how much the Justice Department says ithas recovered through False Claims Act cases involving fraud against federal health care programs since January 2009, when the government began ramping up scrutiny of the sector.

SOUTH CAROLINA GOV SIGNS 20-WEEK ABORTION BAN — Under the ban, which Gov. Nikki Haley signed on Wednesday, most abortions after 20 weeks are now outlawed in the state. The only exceptions: If the mother's life is at risk or if the fetus has a fatal abnormality.

16 states: That's how many other states have enacted similar laws, although three of those states' laws have been blocked by court challenges.

ANTI-ABORTION GROUPS' EMBRACE OFTRUMP COMPLETE? — It looks that way according to this invite to an event with Donald Trump and Ben Carson and convened by several big anti-abortion and Evangelical leaders. The invite includes SBA List’s Marjorie Dannenfelser, Concerned Women for America’s Penny Nance, Live Action President Lila Rose and Students for Life’s Kristan Hawkins, among other names huge with Evangelical voters. The invite was posted by Erick Ericson.

WHY ONE MAJOR NYC HEALTH SYSTEM IS DOWNSIZING — Mount Sinai Health announced a $500 million plan to drastically reduce the size of Beth Israel Medical Center, a politically fraught move that signals a long-term redrawing of the health care map in Manhattan, POLITICO New York's Dan Goldberg reports.

Administrators' pitch: A smaller, more nimble group of facilities that focus on outpatient care is a far more efficient way to manage health care in the 21st century, and Beth Israel simply isn't financially viable in its current form. More: http://politi.co/248k9lO

WHAT WE'RE READING by Paul Demko

Massachusetts officials have reached a deal to avoid a ballot initiative that could have cost Partners HealthCare, the state’s largest care provider, millions of dollars, according to the Boston Globe: http://bit.ly/1NOmRLj

Rep. Dana Rohrabacher, a California Republican, recently made an interesting disclosure: he turned to medical marijuana to treat his arthritis pain, reports the Washington Post: http://wapo.st/1TL29MO

In the wake of last year’s measles outbreak in California, states are making it harder to skip vaccines, points out Stateline: http://bit.ly/1sPA2SV

Alzheimer’s disease could stem from the toxic remains of efforts by the brain to fight off infections, new research suggests: http://nyti.ms/248dBnd

** A message from the American Cancer Society Cancer Action Network (ACS CAN): When you limit drug therapies, you threaten lives. That’s exactly what’s at risk with Secretary Azar and the administration’s regulatory proposal to delay patients’ access to medicines in Medicare Part D’s “six protected classes.” The current policy has worked for over a decade to ensure patients with complex medical needs can work with their doctors to access the best treatments for their individual diagnoses. The proposed changes would allow Medicare plans to delay access to therapies for patients with cancer or other serious illnesses. Patients living with cancer, organ transplants, epilepsy, HIV/AIDS, or mental illness could lose access to their best chance at survival. It’s wrong and could put patients’ lives at risk. We are joining forces with leading patient and provider advocacy groups to urge Secretary Azar and Congress to protect patients’ lives and stop the proposed changes to the Six Protected Classes. Make your voice heard at fightcancer.org/sixprotectedclasses.**

CORRECTION: CORRECTION: A previous version of Pulse misidentified the Personalized Medicine Coalition.

About The Author : Dan Diamond

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with politicians like Sen. Susan Collins, leaders like Kaiser Permanente’s Bernard J. Tyson and thinkers like Atul Gawande.

Along with his partner Rachana Pradhan, Diamond’s high-impact reporting resulted in the resignation of HHS Secretary Tom Price. Diamond also has done prize-winning reporting on hospitals’ community obligations and deep investigations into the Trump administration’s health care strategy, including its approach to vulnerable populations.

Before joining POLITICO, Diamond served as the Advisory Board Company’s senior director of news and communications. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has appeared to discuss health care, politics, and policy on NPR's "All Things Considered" and "Fresh Air," the NBC Nightly News, the BBC, CBS, CNN, MSNBC, the Dan Patrick Show, and other programs. Diamond has been a Yale University Poynter fellow and a fellow of the Association of Health Care Journalists.